My 2 cents

Table of Contents

• Introduction: The Invisible Lines
• 1. Making Up the Science: Medicine on the Plantation
• 2. Institutionalizing Neglect and Dismantling the Pipeline
• 3. Exploitation in the Name of Science
• 4. The Digital Jim Crow: Hardware Blind Spots, Algorithmic Bias, and Modern Care
• Conclusion: Dismantling the Blueprint
• Glossary
• Selected Bibliography

Introduction: The Invisible Lines

Growing up in the rural South in the 1960s, a child learns early that the world is built on invisible, rigid lines. I spent my early childhood in Norway, South Carolina—a tiny town of roughly five hundred residents physically divided by a set of railroad tracks running down the middle, separating the Black community from the white community. With only a grocery store and a gas station to serve the local population, anything beyond the basics meant traveling out of town. Medical care, in particular, meant making the seven-mile journey down the road to Denmark, South Carolina, to the office of Dr. Thomas, a local white physician who treated my grandmother for years.

Two vivid memories from that era, before I turned six years old, defined my earliest understanding of how race dictated care.

The first took place around 1967. Even though the landmark Civil Rights Act of 1964 had formally outlawed segregation, South Carolina was notoriously resistant to change; I did not set foot in an integrated classroom until 1970. On this particular visit, the “colored” waiting room was completely packed. With nowhere left to sit, the staff uncharacteristically allowed my grandmother and me to wait in the “white only” section.

The contrast was immediate and jarring. The white waiting room was immaculate, open, and flooded with natural light, while our designated room was dim, cramped, and neglected. To my five-year-old eyes, the inequity made no sense, and I innocently blurted out, “Ma, why is the white section so bright and clean, but the colored section is so dark and dirty?”

My grandmother was mortified. The reality of Jim Crow required silence for survival, and I was immediately shushed and chastised. The lesson landed instantly: you could see the disparity, but you dared not speak it.

The second memory was far more dangerous. I was about four or five, trailing behind my older cousin and one of his teenage friends outside the home of our next-door neighbor, Mrs. Sug. His friend was riding a bicycle around the house, and my cousin decided to jump out from around the corner with an axe to frighten him. It was a reckless teenage stunt, but I was small and curious, hovering right at my cousin’s knees in eager anticipation.

Just as the bicycle rounded the corner, I peeked my head out. My cousin swung the axe to startle his friend, entirely unaware of where I was standing. The blade struck me squarely across the front of my forehead, knocking me out cold.

The next moments came in fragments: Mrs. Sug carrying me back toward my grandmother’s house while my cousin wept hysterically, followed by another blackout. When I came to, I was lying on an examination table in Dr. Thomas’s office.

A serious head trauma from a metal blade would reasonably demand urgent, thorough intervention: sutures to close the wound, antiseptic care, and a hospital transfer for X-rays to assess for a skull fracture or internal hemorrhaging. None of that happened. Dr. Thomas simply lifted the flap of skin hanging from my forehead, brushed on a swab of iodine, wrapped my head in a standard white gauze bandage, and sent me home.

By the grace of God, I survived without catastrophic complications. Yet that moment cemented an unspoken reality: for Black patients, standard protocols and basic medical vigilance were routinely treated as optional.

Many are familiar with watershed moments of medical exploitation, from the catastrophic decades of the Tuskegee Syphilis Study to the uncredited taking of Henrietta Lacks’s cells. But as devastating as those tragedies were, they are part of a much larger, institutional tapestry. The systematic neglect, experimentation, and structural disregard directed at Black Americans and women has been foundational to the American medical enterprise—and its legacy directly shapes the diagnostics, algorithms, and clinical biases we still face today.

To understand how modern medicine inherited these inequities, we have to look back at the beginning.

1. Making Up the Science: Medicine on the Plantation

Long before diagnostic software and computerized clinical algorithms existed, the American medical establishment actively used the language of objective science to legitimize racial hierarchy and human bondage. In the antebellum South, medicine was not merely adjacent to the institution of chattel slavery—it was one of its most potent intellectual defenders. White physicians manufactured biological justifications to prove that Black people were inherently inferior, less sensitive to physical trauma, and physiologically designed for forced agricultural labor.

Inventing Disorders and Weaponizing the Spirometer

Perhaps no figure embodied this weaponization of medicine more clearly than Dr. Samuel Adolphus Cartwright. An influential physician tasked by the Medical Association of Louisiana to report on the “diseases and physical peculiarities of the negro race,” Cartwright presented a landmark paper in 1851 that dressed political subjugation in diagnostic authority.

Cartwright famously fabricated psychiatric diagnoses to pathologize the basic human desire for freedom. He coined the term Drapetomania to define the “disease” that caused enslaved people to flee plantations, prescribing preventative whippings and hard labor as medical treatment. He also created Dysaesthesia Aethiopica—which overseers referred to as “rascality”—to explain perceived laziness, insubordination, or destruction of property among the enslaved, claiming it stemmed from an innate breakdown of the nervous system.

Yet Cartwright’s most enduring legacy was not merely psychiatric fiction; it was the biological distortion of diagnostic hardware. Utilizing the spirometer—a tool newly invented by English physician John Hutchinson to measure lung capacity—Cartwright conducted tests claiming that Black people possessed roughly 20% lower vital lung capacity than white individuals.

Rather than recognizing that malnutrition, exhausting field conditions, and environmental exposure restricted respiratory health, Cartwright argued that lower lung capacity was an innate, permanent racial deficit. He claimed that forced physical labor was a physiological necessity that expanded Black lungs and stimulated blood circulation, declaring slavery to be medically therapeutic. This flawed methodology established the foundational precedent for “race-correction” in pulmonary diagnostics—a built-in numerical adjustment that persisted in modern spirometry software for well over a century.

The “Father of Gynecology” and Exploitation Without Anesthesia

While Cartwright manipulated diagnostic theory, other physicians turned Black bodies into surgical testing grounds. In Montgomery, Alabama, between 1845 and 1849, Dr. J. Marion Sims conducted experimental surgeries on enslaved women to pioneer techniques for repairing vesicovaginal fistulas—a catastrophic and painful complication of prolonged childbirth.

Operating in a makeshift backyard hospital, Sims leased enslaved women from local slaveholders to serve as his continuous test subjects. Among them were three young women whose names survive: Anarcha, Betsey, and Lucy.

Sims subjected Anarcha to more than thirty unanesthetized surgical procedures on her pelvic region. While ether anesthesia had been discovered and was actively entering mainstream medical practice during the late 1840s, Sims chose to withhold it from his enslaved subjects. He defended this practice with the widely accepted medical myth of the era: that Black people possessed thicker skin, less delicate nervous systems, and a naturally high tolerance for physical agony.

Instead of anesthetics, the women were physically restrained by other enslaved patients or surgical assistants, receiving only post-operative opiates to manage their bowel movements. Once Sims perfected his surgical technique and suture materials on Anarcha and her peers, he returned to New York, established the Woman’s Hospital of the State of New York, and began treating wealthy white women for the same condition—this time administering anesthesia.

Sims was celebrated for decades as the undisputed “father of modern gynecology,” his statue standing prominently in Central Park until public outcry forced its removal in 2018. But the foundational reality remains: modern surgical obstetrics and clinical assumptions about pain tolerance were built upon the unconsenting, unanesthetized bodies of enslaved women.

The pseudoscientific frameworks forged by Cartwright and Sims did not disappear with the Emancipation Proclamation. Instead, they evolved, embedding false assumptions about biological difference directly into the textbooks, clinical training, and standard operating procedures of American medicine.

2. Institutionalizing Neglect and Dismantling the Pipeline

Following the Civil War and the collapse of Reconstruction, the American medical establishment faced a structural question: how would healthcare operate in a society where Black Americans were no longer property, but citizens? Rather than integrating facilities or extending equitable resources, the response was systemic abandonment. The devastating health disparities that emerged among newly emancipated Black communities—born of widespread poverty, displacement, and a total absence of sanitation infrastructure—were weaponized by prominent white physicians to argue that Black people were biologically unsuited for freedom and inevitably headed toward extinction.

To survive, the Black community had to build its own medical infrastructure from scratch. Black churches, civic groups, and philanthropists established independent clinics, nursing programs, and medical schools. By the turn of the twentieth century, several institutions were actively training Black clinicians, including Leonard Medical School in North Carolina, Flint Medical College in Louisiana, and Knoxville Medical College in Tennessee.

Then came the Flexner Report.

The Flexner Report of 1910 and the Physician Deficit

In 1910, educator Abraham Flexner published Medical Education in the United States and Canada, a sweeping survey commissioned by the Carnegie Foundation and backed heavily by the American Medical Association (AMA). Flexner’s mandate was to modernize and standardize medical education, which had long been flooded with proprietary, unregulated diploma mills.

While the report successfully introduced rigorous laboratory science and clinical hospital rotations into mainstream medical curricula, its rigid criteria were devastating to under-resourced institutions. Flexner evaluated schools based on deep institutional endowments, extensive laboratory facilities, and access to major teaching hospitals—resources that historically Black institutions, operating in a segregated economy without state support, simply did not possess.

Flexner’s commentary on Black medical education was explicitly paternalistic. He argued that Black physicians should be trained primarily as “sanitarians” rather than full-fledged medical practitioners, tasked only with hygiene to prevent the spread of infectious disease into adjacent white communities.

The report led state licensing boards and philanthropic foundations to abruptly pull funding and accreditation from schools that did not meet the new capital-intensive standards. Consequently, five of the seven existing Black medical colleges were forced to permanently close:

• Leonard Medical School (Shaw University, Raleigh, NC)
• Flint Medical College (New Orleans, LA)
• Knoxville Medical College (Knoxville, TN)
• Chattanooga National Medical College (Chattanooga, TN)
• University of West Tennessee College of Medicine and Surgery (Memphis, TN)

Only two Black medical schools survived: Howard University College of Medicine in Washington, D.C., and Meharry Medical College in Nashville, Tennessee.

The destruction of these training pipelines created an acute, compounding shortage of Black physicians that echoed for generations. Modern demographic studies in health policy estimate that the closure of those five schools resulted in a deficit of tens of thousands of Black doctors throughout the twentieth century—a gap that directly contributed to the entrenched health disparities in rural and underserved Black communities.

Segregated Halls and the Second-Class Standard of Care

For the Black doctors who did graduate from Howard and Meharry, professional practice was severely restricted. The American Medical Association systematically excluded Black physicians by allowing local and state medical chapters—particularly in the South—to enforce white-only membership policies. Because hospital admitting privileges and specialty board certifications were universally tied to AMA membership, Black physicians were barred from treating their own patients inside local hospitals.

In response, Black clinicians formed the National Medical Association (NMA) in 1895 in Atlanta, Georgia, creating an independent platform to advocate for Black physicians and their patients.

For everyday Black patients, the physical reality of healthcare under Jim Crow was a reflection of the town lines running through places like Norway and Denmark, South Carolina. Most municipal and private hospitals were entirely segregated:

• Denied Admission: Black patients were regularly turned away from local emergency rooms, often resulting in death during long transports to distant facilities that accepted “colored” cases.
• Basement Wards: Hospitals that did admit Black patients relegated them to unventilated basements, converted storage rooms, or poorly supplied annexes, physically hidden beneath the modern, well-equipped white wards above.
• The Routine of Substandard Treatment: In local rural clinics, the standard of care was treated as a separate, lower category. Complex diagnostic evaluations, surgical sutures, and preventative imaging were frequently withheld, replaced by minimal first aid, superficial treatments, and a swift dismissal out the back door.

By institutionalizing segregation in medical training, professional societies, and hospital walls, the American medical system ensured that unequal care was not merely the result of individual prejudice—it was the law and standard practice of the land.

3. Exploitation in the Name of Science

By the mid-twentieth century, the racial hierarchies established in the antebellum era had evolved from crude physical segregation into formal clinical research. Black Americans were no longer merely excluded from quality care; their bodies were treated as disposable raw material for the advancement of modern medical science. Conducted under the auspices of elite universities, federal health agencies, and state-sanctioned programs, these practices operated under a shared assumption: the health, autonomy, and consent of Black patients were entirely secondary to scientific curiosity and institutional profit.

The Forty-Year Betrayal: The Tuskegee Syphilis Study

In 1932, the United States Public Health Service (USPHS), in collaboration with the Tuskegee Institute, launched what was officially titled the “Tuskegee Study of Untreated Syphilis in the Negro Male.” Enrolling 600 impoverished Black sharecroppers in Macon County, Alabama—399 with latent syphilis and 201 uninfected controls—the government promised the men free medical exams, free meals on clinic days, and a $50 burial stipend to ensure an autopsy could be performed upon death.

The men were never told they had syphilis. Instead, researchers informed them they were being treated for “bad blood,” a local colloquialism used to describe a broad range of ailments from anemia to fatigue. In truth, no real treatment was ever administered; the men received mere placebos, diagnostic spinal taps disguised as “special treatments,” and mineral tonics.

By 1947, penicillin emerged as the undisputed, widely available gold standard cure for syphilis. Rather than treating the participants, USPHS researchers actively intervened to withhold the antibiotic. They tracked the men across county lines, provided local doctors with lists of subjects who were not to receive penicillin, and coordinated with local draft boards during World War II to exempt participants from military service so military physicians would not discover and treat their infections.

For forty years, government scientists watched the predictable, devastating trajectory of tertiary syphilis run its course: blindness, neurological degeneration, cardiovascular collapse, dementia, and death. The study ended only in 1972, after Peter Buxtun, an epidemiological investigator with the USPHS, leaked internal documents to journalist Jean Heller of the Associated Press. By that time:

• More than 100 men had died directly from advanced syphilis or related complications.
• At least 40 wives had contracted the infection from their untreated husbands.
• 19 children were born with congenital syphilis.

Henrietta Lacks: Biomedical Riches and the Absence of Consent

While federal researchers in Alabama observed the slow destruction of human life, an unconsented tissue extraction in Baltimore, Maryland, was fundamentally altering the trajectory of global biotechnology.

In 1951, a 31-year-old Black mother of five named Henrietta Lacks visited the “colored ward” of Johns Hopkins Hospital—one of the few major medical centers in the region treating Black patients—for severe abdominal pain and abnormal bleeding. She was diagnosed with an aggressive form of cervical cancer.

During her radium radiation treatments, a surgical sample of her tumor was excised without her knowledge or consent and handed to Dr. George Gey, head of tissue culture research at the hospital. While previous human cells routinely died in laboratory petri dishes within days, Lacks’s cells possessed an extraordinary, unprecedented biological trait: they doubled every 20 to 24 hours, surviving indefinitely.

Named HeLa after the first two letters of her first and last name, these became the world’s first immortal human cell line. Over the next seven decades, HeLa cells became the bedrock of modern medical innovation:

• Powering the development of Jonas Salk’s polio vaccine in 1954.
• Facilitating the creation of chemotherapy drugs, gene mapping, and in vitro fertilization (IVF).
• Serving as critical research material for radiation toxicity, space biology, and treatments for HIV/AIDS and COVID-19.

Yet, as pharmaceutical corporations, biomedical conglomerates, and academic researchers generated billions of dollars in commercial patents and life-saving therapies from HeLa, Henrietta Lacks died in agony later that year and was buried in an unmarked grave. For more than two decades, her family remained entirely unaware that her living cells were reproducing across the globe. Even after the discovery, her descendants lived for decades without basic health insurance, unable to afford the very medications and medical breakthroughs derived directly from their matriarch’s stolen biology.

State-Sanctioned Sterilization: The “Mississippi Appendectomy”

Exploitation extended far beyond laboratory research and into reproductive control. Throughout the twentieth century, more than thirty states enacted formal eugenics legislation aimed at purging “undesirable” traits from the population, disproportionately targeting poor, disabled, Black, Indigenous, and Hispanic women.

In the rural Deep South, surgical sterilization of Black women was so pervasive, casual, and normalized that civil rights icon Fannie Lou Hamer coined the term “Mississippi appendectomy.” In 1961, Hamer entered a hospital in Ruleville, Mississippi, to have a small uterine fibroid removed; without her consent or knowledge, the attending white physician performed a complete hysterectomy.

These non-consensual procedures were systematically financed through federally subsidized family planning clinics and county welfare offices. Young Black women seeking treatment for routine abdominal complaints, undergoing routine childbirth, or applying for food assistance were coerced into signing surgical consent forms—often under threat of losing their public assistance or while heavily sedated during active labor.

In 1973, the Southern Poverty Law Center brought national attention to the practice in the landmark federal case Relf v. Weinberger, revealing that two Black sisters from Alabama, Minnie Lee (age 12) and Mary Alice Relf (age 14), had been surgically sterilized by a federally funded clinic after their illiterate mother was misled into placing an “X” on a form she believed authorized birth control shots. The subsequent federal investigation revealed that between 100,000 and 150,000 poor women, predominantly women of color, had been sterilized under federal programs in the preceding decades.

These mid-century abuses were not isolated anomalies perpetrated by rogue actors; they were deliberate policies executed by the most respected institutions of American medicine and state power. They established a legacy of profound clinical distrust—and created the blueprint for how marginalized bodies could be extracted for data and discarded in practice.

4. The Digital Jim Crow: Hardware Blind Spots, Algorithmic Bias, and Modern Care

It is tempting to view the abuses of the past—from antebellum surgical experiments to mid-century syphilis studies—as relics of a bygone era. Yet the fundamental mechanics of unequal care never truly disappeared; they simply migrated into lines of code, software calculators, and hardware engineering. In the twenty-first century, medical discrimination is rarely announced with a “colored waiting room” sign or an overt refusal to treat. Instead, it operates silently through automated decision trees, laboratory calibrations, and clinical diagnostic guidelines that carry the DNA of historical bias into modern hospitals.

Hardware Calibrated for the Majority: The Pulse Oximeter

During the height of the COVID-19 pandemic, a small fingertip sensor became the primary arbiter of hospital admission, supplemental oxygen allocation, and experimental drug access: the pulse oximeter. Invented in the 1970s and refined over decades, the device measures blood oxygen saturation ($SpO_2$) by passing red and infrared light through the translucent tissue of the finger.

Yet the hardware’s fundamental physics were calibrated almost exclusively on light-skinned individuals. In patients with higher concentrations of epidermal melanin, the pigment absorbs and scatters light differently, causing the sensor to overestimate true arterial blood oxygen levels.

Landmark studies published in the New England Journal of Medicine and JAMA documented that pulse oximeters exhibited “occult hypoxemia”—failing to detect dangerously low blood oxygen levels—in Black, Hispanic, and Asian patients at nearly three times the rate of white patients. A readout that displayed a reassuring 92% oxygen level was frequently masking a true, life-threatening arterial level below 88%.

This hardware blind spot was not a minor technical glitch; it carried mortal consequences. Patients with darker skin were systematically sent home from emergency rooms without supplemental oxygen, experienced delayed prescriptions for critical antivirals, and suffered higher rates of in-hospital organ failure and death because an uncalibrated piece of plastic falsely claimed they were breathing fine.

Automating the Color Line: Algorithmic Race Corrections

While pulse oximeters demonstrated hardware bias, clinical diagnostic software embedded racial hierarchy directly into institutional math. For decades, routine lab work across the United States utilized “race-corrected” algorithms that altered clinical scores based purely on a patient’s perceived race:

• The eGFR Kidney Function Modifier: The estimated Glomerular Filtration Rate (eGFR) is the standard metric used to measure kidney function and diagnose chronic renal failure. Standard equations (such as MDRD and CKD-EPI) incorporated a built-in mathematical multiplier that automatically inflated the estimated kidney health score for Black patients by up to 16%. Grounded in the archaic, disproven premise that Black individuals have naturally higher muscle mass and creatinine production, this automated inflation meant that Black patients had to become significantly sicker than white patients with identical lab values before qualifying for specialist nephrology care or earning a spot on the national kidney transplant waiting list.
• The VBAC Risk Calculator: The standard Vaginal Birth After Cesarean risk tool included race and Hispanic ethnicity as negative risk factors, automatically assigning women of color lower predicted chances of successful labor. This statistical penalty directly nudged obstetricians toward ordering repeat surgical C-sections—a major abdominal surgery carrying substantially higher maternal morbidity and mortality risks.

These equations were not derived from genetic or biological realities; they used socially constructed racial categories as crude proxies, treating human difference as a baseline pathology. In recent years, sustained pressure from clinicians and researchers led major organizations, including the National Kidney Foundation and the American Society of Nephrology, to recommend stripping the race modifier from eGFR formulas. Yet across thousands of independent labs, commercial diagnostic systems, and hospital electronic health record (EHR) systems, the uncoupling of these legacy formulas has taken years to uniformly execute.

The Persistence of Pain Myths

Nowhere is the line between 19th-century plantation medicine and 21st-century practice more direct than in the assessment and treatment of physical pain. The pseudoscientific myths popularized by J. Marion Sims and his contemporaries—that Black people possess thicker skin, denser nerve structures, and a naturally elevated pain threshold—survived intact across generations of medical training.

A landmark 2016 study published in the Proceedings of the National Academy of Sciences (PNAS) revealed that roughly half of surveyed medical students and residents held false biological beliefs about racial differences in biology, such as believing Black patients have thicker skin or less sensitive nerve endings. Crucially, trainees who endorsed these false beliefs rated Black patients’ pain as significantly lower and made less accurate, less adequate treatment recommendations.

This bias translates directly into everyday emergency medicine:

• Black patients presenting with acute, severe pain—such as long-bone fractures, severe kidney stones, or appendicitis—are statistically significantly less likely to receive opioid analgesics compared to white patients presenting with identical trauma.
• In pediatric care, Black children presenting to emergency departments with acute appendicitis receive pain medication at significantly lower rates than their white peers.

From the sensor on a patient’s finger to the automated formula on a lab report and the clinical assessment of a broken bone, modern medicine frequently delivers unequal care not because individual doctors intend harm, but because the entire diagnostic architecture was built to normalize disparity.

Conclusion: Dismantling the Blueprint

Looking back across the decades, the throughline of American medicine becomes unmistakably clear. The line that began in the antebellum South—where forced labor was prescribed as respiratory therapy and surgical techniques were honed on unanesthetized enslaved women—did not vanish with the abolition of slavery. It merely reorganized itself.

It manifested for me in the segregated clinic of Denmark, South Carolina, where I, a five-year-old child, could instantly perceive the contrast between the brightness of white privilege and the dim, neglected corners reserved for Black care. It revealed itself when an axe wound to my forehead was met not with the rigorous diagnostic urgency of stitches, antiseptic cleansing, or an X-ray, but with a swipe of iodine, a strip of white gauze, and a hasty dismissal.

And today, that same line persists inside the digital architecture of modern healthcare.

When a pulse oximeter misreads oxygen levels through melanin-rich skin, when an automated algorithm delays a kidney transplant for a Black patient, or when an emergency physician under-prescribes pain medication under the subconscious belief in higher pain tolerance, the system is not malfunctioning. It is operating precisely as it was historically designed to operate—around a standard that treats the white body as the universal default and all others as secondary.

The danger today is that bias no longer requires overt malice or Jim Crow signage to cause catastrophic harm. When disparity is automated into hardware sensors, clinical scoring rubrics, and diagnostic criteria, it operates with the clinical veneer of objective math. It functions invisibly, shielded by the assumption that machines and data are inherently neutral.

True equity in medicine requires more than passive goodwill or diversity statements. It requires a rigorous, systemic audit of the tools, technologies, and training curricula inherited from a compromised past:

• Hardware and Clinical Calibration: Demanding that all medical devices, sensors, and diagnostic software be rigorously tested, calibrated, and validated across diverse skin tones and demographic profiles before receiving regulatory clearance.
• Algorithmic Audits: Continuously evaluating artificial intelligence, risk prediction models, and clinical decision trees to ensure they do not encode legacy racial proxies or perpetuate disparate outcomes.
• Rebuilding the Pipeline: Actively investing in historically Black medical institutions and expanding the pipeline of Black physicians, reversing the century-long generational deficit engineered by the Flexner Report.
• Curriculum Reform: Rooting out persistent pseudoscientific myths in medical education, ensuring that future clinicians are taught to recognize clinical presentations across all skin pigments and to treat every patient’s pain with equal dignity and urgency.

The scar left on my forehead from an axe in the 1960s healed, but the memory of the casual, substandard care that accompanied it remains sharp. Healing the deep, structural fractures within the American medical system requires that we stop averting our eyes from how we got here. Only by confronting the full history of discrimination in medicine can we finally build a system where the quality of care, the precision of a diagnosis, and the preservation of human life are truly guaranteed for everyone.

Glossary

• Drapetomania: A pseudoscientific mental illness manufactured in 1851 by antebellum physician Dr. Samuel Adolphus Cartwright, claiming that the urge of enslaved Black people to flee captivity was caused by a treatable medical disorder.
• Dysaesthesia Aethiopica: A fabricated 19th-century diagnosis created by Dr. Samuel Adolphus Cartwright to pathologize resistance, perceived laziness, or destruction of property among enslaved individuals, attributing it to an innate breakdown of the nervous system.
• eGFR (Estimated Glomerular Filtration Rate): A standard clinical mathematical calculation used to assess kidney function based on serum creatinine levels. For decades, common formulas included an automated race-adjustment multiplier that artificially inflated estimated kidney performance in Black patients.
• Flexner Report (1910): A landmark study titled Medical Education in the United States and Canada, authored by Abraham Flexner for the Carnegie Foundation, which standardized medical training while precipitating the closure of five of the nation’s seven historically Black medical colleges.
• HeLa Cells: The world’s first immortalized human cell line, derived from a cervical cancer biopsy taken from Henrietta Lacks in 1951 without her knowledge or consent, which became foundational to global biomedical research.
• Mississippi Appendectomy: A mid-20th-century Southern colloquialism coined by civil rights activist Fannie Lou Hamer to describe the routine, involuntary, and non-consensual surgical sterilization of Black women performed during unrelated medical procedures.
• Occult Hypoxemia: A life-threatening clinical state where a patient’s true arterial blood oxygen saturation drops dangerously low (e.g., $<88\%$) while a non-invasive pulse oximeter falsely reads within the normal range ($>92\%$).
• Race-Correction (Clinical Algorithms): The practice of including categorical race or ethnicity variables into diagnostic equations and clinical risk calculators, treating socially defined demographic categories as biological determinants.
• Spirometer: A diagnostic device designed to measure vital lung capacity and airflow. Historically used by Dr. Samuel Cartwright to claim natural respiratory inferiority in Black populations, establishing early precedents for pulmonary race norming.
• Vesicovaginal Fistula: An abnormal, debilitating opening between the bladder and the vagina typically caused by obstructed childbirth, the surgical repair of which was developed by Dr. J. Marion Sims through experimental surgeries on enslaved women without anesthesia.

Selected Bibliography

• Boulware, L. E., et al. (2021). “Eliminating Race-Based Medicine: A Call to Action for Nephrology.” New England Journal of Medicine, 385(12), 1057–1059.
• Flexner, A. (1910).Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (Bulletin No. 4). Carnegie Foundation.
• Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.” Proceedings of the National Academy of Sciences (PNAS), 113(16), 4296–4301.
• Jones, J. H. (1993).Bad Blood: The Tuskegee Syphilis Experiment (Expanded ed.). Free Press.
• Sjoding, M. W., Dickson, R. P., Kuhn, T. S., & Valley, T. S. (2020). “Racial Bias in Pulse Oximetry Measurement.” New England Journal of Medicine, 383(25), 2477–2478.
• Skloot, R. (2010).The Immortal Life of Henrietta Lacks. Crown Publishing Group.
• Vyas, D. A., Eisenstein, L. G., & Jones, D. S. (2020). “Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms.” New England Journal of Medicine, 383(9), 874–882.
• Washington, H. A. (2006).Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Doubleday.